2014 FEMA Incident Support Team (IST) Application Directions:
All applications must be submitted as directed to be considered for an IST position.
 If you are applying for more than one position, submit a separate application for each position
 Obtain signatures for all documents that require signature
 Scan complete application, endorsement letter(s), and supporting documentation to create one (1) .pdf
(Adobe) file (one per position to which your applying)
 Please label the document prior to upload with your first initial and last name, task force & position
applied for (Example: KBevan-UTTF1-Situation)
 The completed electronic application, letter and supporting documents shall be submitted (in one
electronic file) to: Submit 2015 IST Application
ALL APPLICATIONS SHOULD INCLUDE:
 Application: (below) Electronically fill out, print, and sign
o Application personal information
o General Requirements:
o Position Specific Requirements:
o Education and other Training
o Experience (relevant to the position applied for)
o Management (Ability)
o Endorsements
 Endorsement Letter(s): Fill in applicable information, print and obtain signatures
o Endorsement letter from the Sponsoring Agency
o Endorsement letter from the Participating Agency (if applicable)
 Supporting Documentation: Refer to IST Training Matrix
o Attach supporting documentation for each general and position-specific requirement. Each piece of
supporting documentation shall be in order and numbered accordingly, based on the position to
which you’re applying and cross-referenced with the documents titled “General Requirements” and
“Position-Specific Requirements” included in the application. Refer to the IST Training Matrix &
2015 IST Position Description to determine which requirements are necessary for the position to
which you’re applying.
 Example: The first requirement listed is First aid /CPR (General Requirement), so a “1”
should be written in on the top-right side of the supporting documentation for First aid / CPR.
.
FEMA National US&R Response System
Incident Support Team Position Application
POSTED POSITION:
Applicant Information
Last Name
First
M.I.
Street
Address
Date
Apartment/Unit #
City
State
Phone
E-mail Address
Task Force:
ZIP
Current Task Force
Position
FEMA SID#
Are you currently Deployable?
YES
NO
Have you participated in a Task Force Full Scale Exercise?
Have you deployed with your Task Force?
YES
NO
Name of Last Incident?
Previous Work Group or Subgroup Appointment?
YES
NO
Name of WG or SG?
Previous Ad-Hoc Group Appointment?
YES
NO
Name of Ad-Hoc(s)?
YES
NO
DESCRIBE YOUR PROFESSIONAL ORGANIZATION
Fire Department
EMS Provider (Paramedic / EMT)
Medical Professional (MD, PA, Nurse, Other)
Administration / Staff Support
Law Enforcement
Support Services / Supply
Military
Engineering / Construction
REFERENCES
Please list three professional references.
Full Name
Position/Title
Organization
Phone
Full Name
Position/Title
Organization
Phone
Full Name
Position/Title
Organization
Phone
General Requirements
Yes
Endorsement Letter from Sponsoring Agency Chief /
Participating Agency:
No
Task Force Contact Information
Program Manager
Endorsement letter from Employer signed by
Authorized member:
Task Force
Representative
Name
Phone
Name
Phone
Position(s) held relative to the application & number of years in
each position (shall be used to support required experience).
Name / Address of Current Employer
Name:
Position Held
Yrs
Address:
Position Held
Yrs
Position Held
Yrs
Position Held
Yrs
City
Zip
State
GENERAL REQUIREMENTS
Document how you have met the General Requirements for the Position. Please attach documentation to Application in the order listed below.
Additional related supporting documents should be attached after all other required documents in the application. Signed letters submitted as proof of
course completion must be on official department letterhead. If a specific course is not required for the position being applied for, delete the
entire line from the application prior to submitting.
Requirement
Acceptable Documentation / highlight existing text and replace with
explanation of document being submitted for review.
CPR
Current CPR, EMT, or Medical Physician license is acceptable. . If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements
Haz-Mat Operations
Current Certificate of Completion, Annual refresher training must be documented
Signed letter on department letterhead from Training Officer indicating meets requirements.
ICS- I-100
Certificate of Completion, Email Confirmation from NIMS Online. . If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
ICS- I-200
Certificate of Completion, Email Confirmation from NIMS Online. . If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
IS-700
Certificate of Completion, Email Confirmation from NIMS Online.
IS-800b
Certificate of Completion, Email Confirmation from NIMS Online.
FEMA US&R
Orientation
Certificate of Completion, Departmental Transcripts,
CISD
Certificate Critical Incident Stress awareness training
Blood-borne
Pathogen
Certificate of initial Blood-borne Pathogen training in accordance with OSHA 29 CFR 1910.1030
NFPA 1670
Awareness
Confined space, Water rescue and Structural Collapse awareness training required Certificate of
Completion, TF Transcripts, or Signed letter from Training Officer indicating compliance along with Date
and Location of Course. Certificates for Operations or Technician level meets this requirement
Respiratory training
per 29CFR 1910.134
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating compliance
along with Date and Location of Course meeting 29 CFR 1910.134 This is not a just a fit test report.
Annual Refresher training must be documented
US&R Operations in
Contaminated
Environment
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating compliance
along with Date and Location of Course.
FEMA Initial Ethics
Orientation IS-33
This required annual course complies with the U.S. Office of Government Ethics initial agency ethics
orientation for all task force members.
Page
Number
Attached
SPECIFIC REQUIREMENTS
Document how you have met Specific Requirements for the Position you are applying for. Refer to the training matrix to determine what
courses are required for a specific IST position. Please attach documentation to application in order given:
Training Requirement
Documentation/ highlight existing text and replace with explanation
of document being submitted for review. Delete those lines that are
not applicable to your position by using the table, delete row option.
ICS-300
Certificate of Completion, Email, Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
ICS-400
Certificate of Completion, Email, Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
GPS Awareness
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating
compliance along with Date and Location of Course.
US&R IST Course *
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating
compliance along with Date and Location of Course, Not required prior to submitting
application.
US&R Logistics
Specialist
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
US&R
Communications
Specialist
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
US&R Technical
Search Specialist
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
NFPA 1006 / 1670
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating
compliance along with Date and Location of Course. Must include all Disciplines and levels
required by NFPA standard. Including Ropes, Confined, Trench, Extrication, Structural Collapse.
FEMA US&R SCT
Course (80 hours)
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
FEMA US&R
Structures Specialist
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
US&R Medical
Specialist Course
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
Search Management
Training
Applicable NWCG/AllHazards IMT Courses
or Equivalent
FEMA US&R Plans
Team Training
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
FEMA TFL Course
Certificate of Completion, TF Transcripts, or Signed letter from Training Officer indicating
compliance along with Date and Location of Course.
PIO Course G290 or
equivalent (All-Hazards
/ NWCG)
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
FEMA public Affairs
L385 Course
Certificate of Completion.
On line IS 350 course
S246 Situation Unit
Leader Training
US&R TF Safety
Officer course
List any functional specific ICS courses:
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
Certificate of Completion
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
Certificate of Completion, or Departmental Transcripts. If using alternate coursework as
compliance, you must submit signed letter from Training Officer indicating meets requirements.
Page
Number
Attached
Education and Other Training Related to the Position. ( add more fields if necessary)
Describe any additional relevant training and education by listing the schools, and training courses that are relevant to the position you are
applying for. Be sure to include any management or supervisory training, advanced ICS and US&R specific training and schooling. Include the
series or level of training course (Awareness, operations, technician), the hours attended, the certifying agency and the dates or the training and
any recertification or refresher training. You can add rows by placing a cursor in the bottom right cell and hitting tab.
School
Name/Certifying
Agency
Major or Topic / Course Subject / Description of
Training
Years /
hours
Attended
Diploma /
Degree /
Certificate
Page
Number
EXPERIENCE (relevant to the position applied for)
Describe your experience (most recent first) as it relates to the position you are applying for, maximum of one page. Experience is
considered to be actual field activity or involvement in emergency response. Participation in planning and preparations for response
should also qualify in this category. Greater value will be given to actual US&R incident response with maximum points reserved for
those who have the greatest amount of experience in actual FEMA IST US&R response involvement. Applicants should include
relevant information in the event or incident box that describes in enough detail how the incident is relevant to the position being
applied for. This section will be used to qualify and quantify the Required Experience section of the IST Position Descriptions.
Position Held
During
Deployment
US&R Event or Incident
Name
Exercise or
Incident
Staging or
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Exercise
Incident
Staging
Operational
Number of
Operational
Periods
Deployment to
Incident/Event Dates
(i.e. 11/01/2014 –
11/06/2014)
Activation
Order # (if
applicable)
MANAGEMENT (Ability)
This is an objective evaluation of a narrative on the application relating to applicants supervisory and management history.
Supervision is considered enforcement of policy and procedure and oversight of individuals. Management involves policy making,
budgeting, discipline and supervision or management of people and programs.
History
ENDORSEMENTS
Applicant - I certify that the information recorded on this application is true and correct. If selected I agree to comply with all position
requirements as identified by the DHS/FEMA National US&R Response System.
Signature
Date
Task Force Representative or Program Manager - I have reviewed this application, and verify the training and experience as listed
and I concur with the applicant’s participation.
Print Name - Title
Date
Signature
IST REVIEW AND APPROVAL/HOLD/DENIED INFORMATION
APPROVED
Name
HOLD (SEE ATTACHED)
Signature
DENIED (SEE ATTACHED)
Date